Healthcare Provider Details

I. General information

NPI: 1376601427
Provider Name (Legal Business Name): CARL H VICTOR MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SCOTCH RD
EWING NJ
08628-2503
US

IV. Provider business mailing address

34 SCOTCH RD
EWING NJ
08628-2503
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-5800
  • Fax: 609-882-5808
Mailing address:
  • Phone: 609-882-5800
  • Fax: 609-882-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA03570800
License Number StateNJ

VIII. Authorized Official

Name: DR. CARL H VICTOR
Title or Position: OWNER
Credential: MD
Phone: 609-882-5800